Livestock Associated Methicillin Resistant Staphylococcus aureus (clonal complex 398) causing bacteremia and epidural abscess.
Int J Infect Dis. 2019 Jan 11;:
Authors: Murra M, Mortensen KL, Wang M
MRSA CC398 has spread from pigs to humans but rarely from person to person, and has been considered less virulent than other MRSA strains. Livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) is known to colonize especially pig farmers. Recent studies show an increased number of people colonized with LA-MRSA CC398 and invasive infections caused by LA-MRSA CC398. We report a case of a previously healthy, 61year old woman admitted to a Danish regional hospital. She presented with fever, severe back pain and bilateral hyperreflexia of patellar- and Achilles-reflexes. Blood tests revealed leukocytosis and elevated C-reactive protein. Empiric antimicrobial therapy with IV piperacillin/tazobactam was initiated, but blood cultures grew MRSA, and antimicrobial therapy was changed to IV vancomycin. Whole-genome sequencing showed that the MRSA strain belonged to LA-MRSA CC398 spa type t011 and was Panton-Valentine leukocidin (PVL) negative. An MRI revealed an epidural abscess at the level of L1-L4. Surgery was performed and pus from the abscess grew MRSA. The duration of antimicrobial therapy was 12 weeks. We report a bacteremia with LA-MRSA CC398 in a previously healthy patient without exposure to livestock or previous admission to a hospital. This case highlights the risk of person-to-person transmission of LA-MRSA CC398 and brings into question whether LA-MRSA CC398 may have a larger pathogenic potential than previously assumed.
PMID: 30641203 [PubMed - as supplied by publisher]